'Silence is death': towards a woman-centred HIV/AIDS prevention.

Secretary-General Kofi Annan highlighted in a BBC interview that the largest demographic group to be targeted by the HIV/AIDS pandemic was women. Taking stock of this reality, he stated: "We've seen women's organizations at the grass-roots level and this is very important, because today in Africa AIDS has a woman's face.... Often they are the innocent victims."

The United Nations Children's Fund reported that in sub-Saharan Africa, where prevalence of the disease is most severe, two girls for every boy (aged 15 to 24) are newly infected with the virus, while in the most affected countries the ratio is five to one among the 15- to 19-year-olds). The Joint United Nations Programme on HIV/AIDS (UNAIDS) reported in 2004 that worldwide women comprised nearly 50 per cent of adults living with the virus, almost 60 per cent of them in sub-Saharan Africa.

In his report "In Larger Freedom: Towards Development, Security and Human Rights For All", Mr. Annan emphasized two imperatives: mobilization of greater political will to formulate and expedite policy decisions related to the disease; and increased financial support for the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Appropriate actions are therefore required to achieve the Millennium Development Goal (MDG) of combating HIV/AIDS and other diseases. Their reversal and eradication, as well as the overall reduction in mortality rates worldwide, by 2015 is the main goal. The report also encourages Member States to prioritize HIV/AIDS-related initiatives, which would require furthering awareness of the disease while attacking stigmatization. "If there is anything we have learned in the two decades of this epidemic, it is that in the world of AIDS, silence is death", the Secretary-General reflected at the launch of the Global Media AIDS Initiative in January 2004. Silence equals death has become something of a catchphrase with regard to AIDS awareness.

The allocation of resources to combat HIV/AIDS would demonstrate a productive relay that would entail treatment and care of people living with the virus, in conjunction with widespread interventions, such as extensive and informed counselling, community activism, educational outreach, a more extensive and equitable distribution of pharmaceutical products, and increased contraception options beyond abstinence and condom use. Institutional efforts, such as research and development in basic and clinical sciences, are also needed.

Few other issues have gone so far as the HIV/AIDS pandemic has in illustrating the impact of gender disparities. African societies are among those requiring conscientious self-assessment and reform when it comes to patriarchal power and its negative effects on women. The blueprint for such reforms has been laid out by the MDG objective to "promote gender equality and empower women". Reducing inequalities has a direct impact on the threat that HIV/AIDS poses to men, women and children today. In 2005, it is estimated that approximately 8,200 persons succumb to the pandemic daily, and the number of women living with the virus has increased since 2002. UNAIDS reported that within the 2002-2004 period, East Asia experienced an increase of 56 per cent, while Eastern Europe and Central Asia followed close with 48 per cent.

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Women are more vulnerable than men and twice as likely to being infected with HIV/AIDS through sexual transmission. This risk exposure is often worsened by the lifestyle choices and beliefs of their male counterparts. For example, the refusal of many African men to wear condoms stems from the assumption that masculinity is best exemplified by impregnation and childbearing. Women find it difficult to negotiate with their partners on contraceptive use due to power disparities, such as in courtship practices and the traditional institution of marriage. In a study cited by UNAIDS, it revealed that only 11 per cent of married Zambian women felt it their right to demand condom use, even if the husband had proven unfaithful and was HIV-positive. Evidently, the contract of marriage is no guarantee for protection against the possibility of exposure to and transmission of the virus.

Patriarchal societies support the idea of male supremacy, placing an emphasis on men's rules and social prerogatives. Women must defer to their husband's authority in sexual and other domestic matters, and those who insist on contraception, abstinence or AIDS testing often face rejection, threat of violence or divorce, family slander and community ostracism. In addition, many women and young girls exchange sex for basic goods and services, including money. This "transactional" sex, especially prevalent in Asia, the Caribbean and sub-Saharan Africa, often leads to other forms of enslavement and coercion. Such gender bias also results in poverty and a lack of educational and employment opportunities for women, who sometimes resort to prostitution in order to make a living. Violence or the threat of violence is endemic to this commercial sex trade.

Clearly, women are part of the HIV/AIDS transmission equation and their participation should not be overlooked. This underscores the importance of education, dialogue and prevention for both men and women. However, women still provide the bulk of home-based care, including raising children, cultivating crops and attending to household duties, which unduly burden their ability to pursue education, financial independence and gainful employment.

The 2001 Declaration of Commitment on HIV/AIDS, titled "Global Crisis--Global Action", recognizes strategies that would collectively reduce women's vulnerability to the disease. It states that the factors that must be expunged from male-centred gender relations include "discrimination, as well as all forms of violence against women and girls, including harmful traditional and customary practices, abuse, rape and other forms of sexual violence, battering and trafficking in women and girls". The Declaration also stresses the "active involvement of men and boys" as a vital component of female empowerment and an anti-AIDS campaign, which are both irrevocably linked.

Although formal education is not universally available, especially in the developing world, a greater degree of freedom for women would elicit productive discussions about taboo or sensitive issues, such as sexuality, condom use and HIV/AIDS. More grass-roots leadership, traditional storytelling, word-of-mouth conveyance and informal group meetings with health-care workers, among others, would serve as public forums for examining past failures and future successes.

RELATED ARTICLE: Beyond the 'ABC' of HIV/AIDS Prevention

For many women in the developing countries, the "ABC" of prevention--abstinence, not being promiscuous and commitment to condom use--fails to offer optimal protection against contracting HIV/AIDS, according to UNAIDS. Vigorous action must be taken by the entire spectrum of the global society to ensure effective treatment, prevention and eradication of the virus. An unchecked proliferation of the disease would over time unleash a Pandora's box of social problems, such as increased mother-to-child transmission.

UNAIDS predicts that between 2002 and 2010, another 45 million people around the world will be infected with HIV unless transmission rates are cut drastically. Also projected is a drastic rise in the number of orphans and single-parent households; there are over 14 million such cases worldwide. Without increased awareness and prevention, the spread of infection will continue through unprotected sex, especially among young people with non-monogamous partners.

In the wake of rising deaths, severe age disparities within a population and domestic imbalances would arise, primarily from the dissolution of the extended family. The threat of a polarized family unit--the very young being cared for by the very old--would burden both the education and healthcare sectors. Particularly hard-hit would be the heavily indebted poor countries, which cannot provide substantial social assistance to AIDS victims and their families.

On a more optimistic front, scientists are exploring the development of an anti-pathogenic product that offers protection for women against sexually transmitted diseases and HIV/AIDS, and could guard them against potentially unwanted pregnancy. As a user-controlled prevention tool to be inserted internally and would virtually be invisible, "microbicides" would allow women to forego negotiating with their partners on other contraceptions, thus overriding the stigma and problems associated with the use of condoms. However, microbicides are not a perfect barrier against the spread of HIV/AIDS, but would allow women at least some degree of self-determination and a sense of empowerment. According to the Global Campaign for Microbicides, scientists believe that even at 60-per-cent effectiveness, microbicide could in three years prevent 2.5 million HIV infections among the populations of the developing world.